Framing Medicine as a Moral Practice: An Introductory Medical School Course

A patient-centered approach to learning social determinants of health for first year medical students

INTRODUCTION

To address health disparities, future physicians must understand the role of social determinants of health (SDH). Teaching SDH can be challenging. We created an authentic SDH curriculum using four real myocardial infarction (MI) patients.

METHODS

During the three academic years from 2019-2020 to 2021-2022, 579 first year medical students participated in the four day curriculum. Day 1: students interviewed and learned about their patient's MI. Day 2: students met in small groups and shared their patient's history. At session end, students were familiar with four patient stories. Day 3: students explored their patient's neighborhood and then interviewed their patient again, focusing on SDH. Day 4: students gave formal patient presentations that highlighted SDH. Group discussion followed and reinforced the role of SDH. Students wrote reflections on SDH that were read and graded. End of course evaluations were reviewed.

RESULTS

Five hundred and seventy-nine students completed the curriculum. Course directors graded SDH reflections on a six-point rubric for the years of 2020-2021 and 2021-2022. Ninety percent and 96% of the SDH reflections during the respective years contained 5-6/6 of the rubric components. Ninety-six percent to 98% of students 'agreed' or 'strongly agreed' that the curriculum was effective for their learning.

DISCUSSION

For educators in need of an SDH curriculum that is both engaging and effective, we have found this activity to be feasible, low cost, and highly impactful for first year medical students.[Box: see text].

Fundamental Curriculum Change with 1-Year Pre-Clerkship Phase and Effect on Stress Associated with Residency Specialty Selection

Vanderbilt University School of Medicine recently changed from 2 pre-clerkship years (Traditional curriculum) to a 1.5-year pre-clerkship phase for one class (Hybrid curriculum) to a 1-year pre-clerkship phase (Curriculum 2.0). This study investigated the relationship between shortened pre-clerkship training and stress associated with selecting a residency field. The surveyed graduating medical student population included one cohort from the Traditional and Hybrid curricula, and the first two cohorts from Curriculum 2.0. The authors modeled recollected stress levels using a Zero-Inflated Linear Mixed Model with additional covariate and random effects adjustments. Specialty decision-related stress levels increased in the Hybrid curriculum by 10.208 points [p = 0.0115, 95% CI 2.293, 18.122] on a 0-100 point scale. Curriculum 2.0 students had an insignificant increase in stress of 4.062 points [p = 0.304, 95% CI - 3.690, 11.814] relative to the Traditional curriculum. Time since starting medical school and time when a specialty was chosen were the largest factors associated with stress. While this study only evaluated a single facet of the potential downstream effects of curricular change, these data should inspire confidence for reform efforts as a significant increase in specialty decision-related stress present in Hybrid curriculum resolved in both cohorts of Curriculum 2.0.